This section was contributed by the Australian Government Department of Health and Ageing.

The Australian (Commonwealth) Government, in conjunction with the state and territory governments and the local governments has put together systems for the delivery of health, income support, and housing and community services to support the ageing people of Australia. All these systems are major areas of concern for all three levels of government, and are described in the National Strategy for an Ageing Australia.

National Strategy for an Ageing Australia

Recognising the significant implications of population ageing across a number of public policy areas, the Australian Government has developed the National Strategy for an Ageing Australia. The Strategy arose from a series of consultations with key stakeholders and from public submissions to six discussion papers put together by the Government. The strategy identifies key issues, a number of goals and some broad, practical actions to meet these goals. It provides a basic framework to address current issues facing older people and to prepare for future demographic changes as Australia's population ages over the next 50 years. It also highlights that the ageing of Australia's population is an issue for all Australians - governments, businesses, community organisations and individuals.

The main themes of the National Strategy, as discussed in the Terms of Reference for the strategy are:

The main purpose of aged care programs is to support healthy ageing for older Australians and quality, cost effective care for frail older people and support for their carers. The system of aged care programs in Australia is structured around two main forms of care delivery: residential and community care. There are various other associated aged care programs such as Day Therapy Centres, Multi-purpose Services and Advocacy Systems, that also form part of the aged care system (diagram 7.21).

7.21 AGED CARE SYSTEM, Australian Government expenditure - 2002-03

(a) Individual programs are described within this chapter.Source: Department of Health and Ageing.

Aged Care Assessment Program

The Australian Government provides grants to state and territory governments specifically to operate Aged Care Assessment Teams (ACATs). In 2002-03, the Government contributed $41.9m for the operation of 119 ACATs throughout Australia, as well as an evaluation unit in each state.

ACATs assess the care needs of people and their eligibility for accessing the required services. The main professional groups represented on ACATs are geriatricians, social workers, nurses, physiotherapists, occupational therapists, psychologists and psychogeriatricians.

ACATs assess the whole care needs of an individual, using a multi-disciplinary and multi-dimensional approach. As part of the holistic assessment process, a person's medical, physical, social, psychological and restorative care needs are assessed before a care approval is made. ACATs are also well positioned to provide advice on aged care services and to act as an interface between aged care services and the health care system.

Clients need to be assessed as eligible by an ACAT before they can receive a subsidy for residential care, a Community Aged Care Package, or some forms of flexible care, such as under the Extended Aged Care at Home (EACH) Program.

Residential Aged Care Program

The aim of the Residential Aged Care Program is to enhance the quality of life of older Australians through support for the provision of a cohesive framework of high quality and cost effective residential care services for frail older people. There are two types of residential aged care, high level care ('nursing home') and low level care ('hostel'). Aged care places are allocated in proportion to the number of people aged 70 years and older.

The Australian Government subsidises the costs for each person in a residential care setting. The level of funding depends on the care needs of the resident. Also, residents can be asked to pay fees and charges. Each aged care home that provides care is required to meet specific care and building standards and to be accredited by the Aged Care Standards and Accreditation Agency in order to receive Government funding. Capital funding is available on a competitive basis to support residential aged care where the aged care provider is unable to fund necessary building works. Australian Government expenditure on residential aged care in 2002-03 is shown in table 7.22.

7.22 COMMONWEALTH EXPENDITURE ON RESIDENTIAL AGED CARE(a)

Residential Care (recurrent)

Residential Care (capital)

$m

$m

2001-02

2002-03

2001-02

2002-03

New South Wales

1,441.9

1,543.0

7.0

4.5

Victoria

973.0

1,046.9

4.6

3.6

Queensland

698.9

774.7

2.8

4.2

South Australia

382.8

347.8

0.8

3.9

Western Australia

322.6

417.6

1.5

2.6

Tasmania

117.1

125.1

1.8

3.8

Northern Territory

11.8

36.1

1.2

0.7

Australian Capital
Territory

39.2

19.1

0.1

0.1

Australia(b)

3,987.3

4,310.3

19.7

23.3

(a) Includes expenditure by the Department of Health and Ageing and the Department of Veterans' Affairs, in accrual terms. Actual expenditures may change slightly due to late claims and adjustments.(b) Totals may vary due to rounding.

Source: Department of Health and Ageing.

Community care programs

The main aim of these programs is to assist people being maintained in their own homes. The main programs are the Home and Community Care, the Community Aged Care Packages and the Extended Aged Care at Home program.

Home and Community Care (HACC) Program

The HACC Program is a joint Australian Government and state government cost-shared program which provided $1,100m nationally for the 2002-03 financial year to service provider organisations. Of the total, the Australian Government made available $674.1m or 60%, with the states and territories providing the remaining 40%.

The Australian Government provides funding for HACC, but the day-to-day administration, priority setting and approval of project allocations is the responsibility of the state and territory governments.

The aim of the HACC Program is to provide basic maintenance and support services to enable frail older people (and younger people with disabilities) to remain living in their home and the community and to prevent premature admission to long-term residential care. HACC funded services also assist the carers of these groups. The types of HACC funded services available include home maintenance and modification, as well as domestic assistance, food services, personal care, community nursing, transport and respite care.

Community Aged Care Packages (CACP) Program

The CACP Program is funded by the Australian Government to provide a community alternative to low level residential care to assist frail older people with complex needs to remain living in the community.

Service providers use a case management approach to develop and monitor care delivery to eligible older people. One of the benefits of the CACP Program is its flexibility in service delivery which is designed to meet individual needs. This flexibility enables people to be given assistance through a package of care services which may include personal care, assistance with preparing meals, home help and assistance with transport.

By June 2003, there have been 27,636 packages approved under the program. Total cash expenditure for 2002-03 was $288.3m.

Extended Aged Care at Home (EACH) Program

The EACH Program commenced as a three-year pilot in 1998 to test the feasibility of providing the equivalent to high level residential age care to people living at home. The Program has expanded to a total of 450 places at 30 June 2003, with funding in 2002-03 of $13.6m.

EACH service providers are required to deliver individually tailored, coordinated packages of care in keeping with a client's care plan. Services can include, but are not limited to, the following:

personal care including continence care

specialist nursing care and 24-hour emergency assistance

support for people with cognitive deficits

assistance with meals

home help and maintenance.

The 2001 Budget Initiative on EACH provided an additional $2m over two years for development work to lay the foundations for possible expansion of the EACH Program and address data management, quality and accountability issues. Through 2002-03 further development was undertaken, including a census of EACH services in May 2002.

In the 2002 Aged Care Approvals Round, 160 EACH packages have been allocated to provide for a moderate expansion of the EACH Program. The expansion targets Tasmania, Queensland and the Northern Territory, none of which hosted a pilot program, plus additional packages for New South Wales and South Australia. This expansion will build provider familiarity with the program, and provide an Australia-wide base for program development.

Other aged care programs

The Australian Government also provides funding for other support and community services. The following are the main programs funded by the Government.

Assistance with Care and Housing for the Aged (ACHA) Program

The ACHA Program assists frail, low-income older people who are renting, are in insecure/inappropriate housing or are homeless, to remain in the community by accessing suitable housing linked to community care.

The Australian Government contributes recurrent funds to organisations that provide support through paid workers and/or volunteers, assisting clients to access and be maintained in secure and affordable housing. The primary role of program workers is to link clients to appropriate mainstream housing and/or care services.

In 2002-03 the program funded 46 projects nationally from an allocation of $2.6m. The funding for each project varies according to identified community need, the number of staff employed by individual services and the tenure of employment (i.e. full-time or part-time). Most projects are located in inner city areas where there is a concentration of frail elderly people living in insecure accommodation.

National Respite for Carers Program (NRCP)

The aim of the NRCP is to contribute to the support and maintenance of caring relationships between carers and their dependent family and friends. It provides information, respite care and other support or assistance appropriate to carers' individual needs and circumstances, and those of the people for whom they care.

A national network of over 90 Commonwealth Carer Respite Centres and regional office outlets has been established to improve coordination of respite service provision and help meet emergency and unplanned respite needs. Commonwealth Carer Respite Centres provide carers with a single contact point for respite care assistance whether the respite service required is in an aged care facility, in the community or in the carer's home. The NRCP provides funding for over 450 carer respite services, which include in-home, family-based, centre-based and peer support services, to supplement mainstream respite services offered through the HACC and other state-based programs as well as local government and community initiatives. An allowance is also paid to carers who are looking after people with high level needs.

Funding for the NRCP increased from $19m in its inception year, 1996-97, to $92.6m in 2002-03. The NRCP funds Commonwealth Carer Resource Centres, Commonwealth Carer Respite Centres and respite services.

Commonwealth Carelink Program (CCP)

Over 60 Commonwealth Carelink Centres across Australia provide information about local community aged care, disability and other support services to over 13,000 clients each month. Clients include care professionals such as general practitioners, service providers, individuals and their carers. Program funding in 2002-03 was $12.4m.

Psychogeriatric Care Units (Dementia) Programs (PCUP)

The Australian Government funds a number of care programs that exclusively or partly target people with dementia and their carers. The Dementia Education and Support Program has an annual budget of $1.4m, and has the primary function of operating a 24-hour National Dementia Helpline that provides an information and referral service as well as acting as a 'gateway' to other more intensive support services. A second telephone support service for carers of people with dementia and challenging behaviours and respite workers is provided under the National Dementia Behaviour Advisory Service. The budget in 2002-03 for this service was $0.4m.

The Early Stage Dementia Support and Respite Project, with an annual budget of $1.4m, provides a nationally coordinated support and respite service for people in the early stages of dementia and their carers. In 2002-03 the Carer Education and Workforce Training with $1.1m provided a coordinated national education and training program, focusing on carers and respite workers. In addition to these services, the Psychogeriatric Care Units, with a 2002-03 budget of $3.4m, provide specialist psychogeriatric support to residential aged care homes and community carers looking after people with dementia who exhibit significant behaviours of concern.

Day Therapy Centres Program (DTCP)

The DTCP has been in operation since 1988 when rationalisation of nursing home funding led to the separate funding of the therapy function. There are 155 service providers across Australia providing a wide range of therapy services to frail older people living in the community and to residents of Australian Government funded aged care homes. Funding provided by the Government in 2002-03 was $31.2m.

National Continence Management Strategy (NCMS)

The 'Staying at Home - Care and Support for Older Australians 1998' package included $15m over four years to address the needs for improved continence management for older Australians through the NCMS. In 2002, an additional $4m per annum for four years was approved for the continuation of the strategy. Under this Strategy, a number of national research and service development initiatives are being trialed to complement existing continence care.

The Australian Government also funds the Continence Aids Assistance Scheme (CAAS) which was established to assist people of working age who have a permanent disability-related incontinence condition. CAAS currently provides a subsidy to eligible individuals of $470 per annum. CAAS funding for 2002-03 was $10m.

Commonwealth Hearing Services Program (CHSP)

The role of the CHSP is to reduce the consequence of hearing loss for eligible clients and reduce the incidence of hearing loss in the broader community. Administration of the CHSP is the responsibility of the Office of Hearing Services (OHS), a branch in the Medical and Pharmaceutical Services Division, Department of Health and Ageing. This branch is also in charge of purchasing hearing systems from accredited public and private sector providers.

Access to hearing services for eligible adults - 21 years and over - is provided through the Hearing Services Voucher System. The Voucher System expenditure in 2002-03 was $156.8m. Eligible adults include:

holders of Pensioner Concession Cards

holders of Gold Repatriation Health Cards issued to Veterans for all conditions

holders of White Repatriation Health Cards issued to Veterans for conditions that include hearing loss

Sickness Allowees

dependants of the above categories

CRS Australia clients undergoing a vocational rehabilitation program and referred by their case manager

serving Defence personnel.

There are 143 accredited hearing services providers contracted by the OHS to provide services under the Hearing Services Voucher System. Services are provided at 366 permanent sites and around 875 visiting sites throughout Australia by qualified hearing services practitioners (audiologists and audiometrists). OHS also has supply contracts with 15 hearing devices suppliers for the supply of quality hearing devices into the Program.

In addition, the Australian Government funds Australian Hearing to provide specialised hearing services for children and young adults under the age of 21 years, and to ensure access to appropriate hearing services for eligible adults with special needs. These clients include those who live in remote locations, who are Aboriginal or Torres Strait Islander peoples, or who have complex hearing needs. Funding is also provided to Australian Hearing Services to undertake, through its research arm, the National Acoustic Laboratories, research to increase understanding of issues related to hearing loss, hearing rehabilitation and the harmful effects of noise. Total funding of these Community Service Obligation activities in 2002-03 was $28.9m.